A commission of experts presented a 66-point plan on Monday that is meant to lower the ever-growing health insurance contributions that Germans have to pay into the system.

Germany's health care system is one of the most expensive in the world, with state health insurers alone spending around €1 billion ($1.15 billion) per day on health care — a number that is expected to rise even more in the next few years. Meanwhile, Germans' insurance contributions to those state health insurers rose by an average of around 3% this year, on top of a 2.5% rise in 2025.

But despite the rising contributions, state insurers' expenses are increasing even more rapidly. At the press conference, the commission held up a graphic — from the state insurers' association, the GKV — which showed that at the current rate, the shortfall between state insurers' income and expenses would increase from €15.3 billion in 2027 to €40.4 billion in 2030.

Closing the health care expenses gap

The 66 recommendations presented on Monday were designed not only to close that gap, but to make even more savings. The 10-member commission, which included experts from the fields of economics, medicine and social law, was specifically charged with coming up with too many recommendations as the government is unlikely to be able to implement all of them, if only for political reasons.

"I'm grateful that the commission has presented us with a well-filled toolbox, from which we will now take the best tools," Federal Health Minister Nina Warken of the conservative Christian Democratic Union (CDU) said at the press conference. "It's important for me to emphasize that there will be no one-sided reforms that will burden the insured. We will not shake the cornerstones of a health care system based on solidarity."

More taxes, fewer operations

The commission's 480-page report included proposals such as:

• A rise in taxes on spirits and tobacco.
• A new tax on sugary drinks. Commission member Ferdinand Gerlach, director of the Institute for General Practice and a doctor himself, said experience in other countries had shown that when sugar taxes are introduced, manufacturers tend to reduce the sugar content of their products voluntarily.
• A new measure requiring plannable operations — such as knee replacements — to only be carried out once the patient has received an independent second opinion from another doctor who has no economic stake in the decision. Germany carries out more such operations than many other EU countries.
• Patients pay more contributions for prescribed drugs. At the moment, health insurers pay for most prescription drugs.
• Breadwinners' spouses with no children under 6 would no longer be insured automatically. This is seen as a particularly controversial recommendation, and Bavarian State Premier Markus Söder, for instance, has already said he would not implement it.
• The federal government, rather than health insurers, should pay for the health care of unemployment benefits recipients. This alone would save insurers €12 billion a year, the commission said. But such a proposal is likely to meet some political opposition, as the government is currently also trying to cut costs in the unemployment benefits system.

Eugen Brysch, chair of the German Foundation for Patient Protection (DSP), an organization that protects patients' rights, said the 66 proposals could all have been found lying in the filing cabinets of various health care organizations, but that it was up to the government to agree on a clear plan.
 
"It's time for the government to show its colors," Brysch told DW in a statement. "The financial gap needs to be addressed. Sustainable health insurance can't be done by a financial commission, only by the government, and for that they need a unified concept."
 
Brysch predicted, for example, that the proposal to have the government pay the health insurance for the unemployed would lead to a political row in the coalition government.

The ins and outs of the German health care system

Germany has a dual health care system funded by employees' and employers' contributions to health insurers. Health insurance is mandatory for the entire population, and state insurers, which cover around 90% of the population, are not allowed to refuse anyone insurance. Around 10% of the population opt for private insurance, which often offers more cover. 

But in the past, critics have raised concerns that hospitals and doctors are incentivized to recommend expensive and unnecessary treatment, burdening the health insurance companies and driving up contributions.

Health Minister Warken promised that the commission's proposals would be examined quickly and that her department would draw up a draft bill to present to the Cabinet by the summer. 

Edited by Rina Goldenberg